Ehrenreich on the Uproar Over Breast Cancer Screenings

This article originally appeared at TomDispatch.

Has feminism been replaced by the pink-ribbon breast
cancer cult? When the House of Representatives passed the Stupak
amendment, which would take abortion rights away even from women who
have private insurance, the female response ranged from muted to
inaudible.

A few weeks later, when the United States Preventive Services Task
Force recommended that regular screening mammography not start until
age 50, all hell broke loose. Sheryl Crow, Whoopi Goldberg, and Olivia
Newton-John raised their voices in protest; a few dozen non-boldface
women picketed
the Department of Health and Human Services.  If you didn’t look too
closely, it almost seemed as if the women’s health movement of the
1970s and 1980s had returned in full force.

Never mind that Dr. Susan Love, author of what the New York Times
dubbed “the bible for women with breast cancer,” endorses the new
guidelines along with leading women’s health groups like Breast Cancer
Action, the National Breast Cancer Coalition,
and the National Women’s Health Network (NWHN). For years, these groups
have been warning about the excessive use of screening mammography in
the U.S., which carries its own dangers and leads to no detectible
lowering of breast cancer mortality relative to less mammogram-happy
nations.

Nonetheless, on CNN last week, we had the unsettling spectacle of
NWHN director and noted women’s health advocate Cindy Pearson speaking
out for the new guidelines, while ordinary women lined up to attribute
their survival from the disease to mammography. Once upon a time,
grassroots women challenged the establishment by figuratively burning
their bras. Now, in some masochistic perversion of feminism, they are
raising their voices to yell, “Squeeze our tits!”

When the Stupak anti-choice amendment passed, and so entered the
health reform bill, no congressional representative stood up on the
floor of the House to recount how access to abortion had saved her life
or her family’s well-being. And where were the tea-baggers when we
needed them? If anything represents the true danger of “government
involvement” in health care, it’s a health reform bill that – if the
Senate enacts something similar — will snatch away all but the
wealthiest women’s right to choose.

It’s not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has
replaced feminism as a focus of female identity and solidarity. When a
corporation wants to signal that it’s “woman friendly,” what does it
do?  It stamps a pink ribbon on its widget and proclaims that some
miniscule portion of the profits will go to breast cancer research.
I’ve even seen a bottle of Shiraz called “Hope” with a pink ribbon on
its label, but no information, alas, on how much you have to drink to
achieve the promised effect. When Laura Bush traveled to Saudi Arabia
in 2007, what grave issue did she take up with the locals? Not women’s
rights (to drive, to go outside without a man, etc.), but “breast
cancer awareness.” In the post-feminist United States, issues like
rape, domestic violence, and unwanted pregnancy seem to be too edgy for
much public discussion, but breast cancer is all apple pie.

So welcome to the Women’s Movement 2.0: Instead of the proud female
symbol — a circle on top of a cross — we have a droopy ribbon.
Instead of embracing the full spectrum of human colors — black, brown,
red, yellow, and white — we stick to princess pink. While we used to
march in protest against sexist laws and practices, now we race or walk
“for the cure.” And while we once sought full “consciousness” of all
that oppresses us, now we’re content to achieve “awareness,” which has
come to mean one thing — dutifully baring our breasts for the annual
mammogram.

Look, the issue here isn’t health-care costs. If the current levels
of screening mammography demonstrably saved lives, I would say go for
it, and damn the expense. But the numbers are increasingly insistent:
Routine mammographic screening of women under 50 does not
reduce breast cancer mortality in that group, nor do older women
necessarily need an annual mammogram. In fact, the whole dogma about
“early detection” is shaky, as Susan Love reminds us:
 the idea has been to catch cancers early, when they’re still small,
but some tiny cancers are viciously aggressive, and some large ones
aren’t going anywhere.

One response
to the new guidelines has been that numbers don’t matter — only
individuals do — and if just one life is saved, that’s good enough. So
OK, let me cite my own individual experience. In 2000, at the age of
59, I was diagnosed with Stage II breast cancer on the basis of one
dubious mammogram followed by a really bad one, followed by a biopsy. 
Maybe I should be grateful that the cancer was detected in time, but
the truth is, I’m not sure whether these mammograms detected the tumor
or, along with many earlier ones, contributed to it: One known
environmental cause of breast cancer is radiation, in amounts easily
accumulated through regular mammography.

And why was I bothering with this mammogram in the first place? I
had long ago made the decision not to spend my golden years undergoing
cancer surveillance, but I wanted to get my Hormone Replacement Therapy
(HRT) prescription renewed, and the nurse practitioner wouldn’t do that
without a fresh mammogram.

As for the HRT, I was taking it because I had been convinced, by the
prevailing medical propaganda, that HRT helps prevent heart disease and
Alzheimer’s. In 2002, we found out that HRT is itself a risk factor for
breast cancer (as well as being ineffective at warding off heart
disease and Alzheimer’s), but we didn’t know that in 2000. So did I get
breast cancer because of the HRT — and possibly because of the
mammograms themselves — or did HRT lead to the detection of a cancer I
would have gotten anyway?

I don’t know, but I do know that that biopsy was followed by the
worst six months of my life, spent bald and barfing my way through
chemotherapy. This is what’s at stake here: Not only the possibility
that some women may die because their cancers go undetected, but that
many others will lose months or years of their lives to debilitating
and possibly unnecessary treatments.

You don’t have to be suffering from “chemobrain”
(chemotherapy-induced cognitive decline) to discern evil, iatrogenic,
profit-driven forces at work here.  In a recent column
on the new guidelines, patient-advocate Naomi Freundlich raises the
possibility that “entrenched interests — in screening, surgery,
chemotherapy and other treatments associated with diagnosing more and
more cancers — are impeding scientific evidence.” I am particularly
suspicious of the oncologists, who saw their incomes soar starting in
the late 80s when they began administering and selling chemotherapy
drugs themselves in their ghastly, pink-themed, “chemotherapy suites.”
Mammograms recruit women into chemotherapy, and of course, the
pink-ribbon cult recruits women into mammography.

What we really need is a new women’s health movement, one that’s
sharp and skeptical enough to ask all the hard questions: What are the
environmental (or possibly life-style) causes of the breast
cancer epidemic? Why are existing treatments like chemotherapy so toxic
and heavy-handed? And, if the old narrative of cancer’s progression
from “early” to “late” stages no longer holds, what is the
course of this disease (or diseases)? What we don’t need, no matter how
pretty and pink, is a ladies’ auxiliary to the cancer-industrial
complex.

Barbara Ehrenreich is the author of 17 books, including the bestsellers Nickel and Dimed and Bait and Switch. A frequent contributor to Harper’s and the Nation, she has also been a columnist at the New York Times and Time magazine. Her seventeenth book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America (Metropolitan Books), has just been published.

Copyright 2009 Barbara Ehrenreich

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